Congenital diaphragmatic hernia: Impact of contemporary management strategies on perinatal outcomes

2018 ◽  
Vol 38 (13) ◽  
pp. 1004-1012 ◽  
Author(s):  
Han‐Shin Lee ◽  
Jan E. Dickinson ◽  
Jason KG Tan ◽  
Wendy Nembhard ◽  
Carol Bower
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Management Strategies ◽  
Perinatal Outcomes ◽  
Contemporary Management

scholarly journals Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

2020 ◽  
Vol 105 (4) ◽  
pp. 449-454
Author(s):  
Emily J J Horn-Oudshoorn ◽  
Ronny Knol ◽  
Arjan B Te Pas ◽  
Stuart B Hooper ◽  
Suzan C M Cochius-den Otter ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Management Strategies ◽  
Fetal Surgery ◽  
Adverse Outcomes ◽  
Delivery Room ◽  
Treatment Modalities ◽  
Mortality And Morbidity ◽  
Early Predictors ◽  
Stabilisation Period

Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.

scholarly journals Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?

2018 ◽  
Vol 35 (10) ◽  
pp. 919-924 ◽  
Author(s):  
Teresa Sparks ◽  
Victoria Berger ◽  
Jody Farrell ◽  
Kristen Gosnell ◽  
Roberta Keller ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Poor Prognosis ◽  
Primary Outcome ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Lung Area ◽  
Liver Herniation ◽  
Secondary Outcomes ◽  
Univariate Analyses

Objective The objective of this study was to examine laterality as a predictor of outcomes among fetuses with prenatally diagnosed congenital diaphragmatic hernia (CDH). Methods This is a retrospective cohort study of pregnancies with CDH evaluated at our center from 2008 to 2016 compared cases with right-sided CDH (RCDH) versus left-sided CDH (LCDH). The primary outcome was survival to discharge. Secondary outcomes included ultrasound predictors of poor prognosis (liver herniation, stomach herniation, lung area-to-head circumference ratio [LHR]), concurrent anomalies, hydrops, stillbirth, preterm birth, mode of delivery, small for gestational age, use of extracorporeal membrane oxygenation, and length of stay. Terminations and stillbirths were excluded from analyses of neonatal outcomes. Results In this study, 157 (83%) LCDH and 32 (17%) RCDH cases were identified. Survival to discharge was similar (64 vs. 66.4%, p = 0.49) with regard to laterality. RCDH had higher rates of liver herniation (90.6 vs. 72%, p = 0.03), hydrops fetalis (15.6 vs. 1.3%, p < 0.01), and lower LHR (0.87 vs. 0.99, p = 0.04). LCDH had higher rates of stomach herniation (69.4 vs. 12.5%, p < 0.01). Rates of other outcomes were similar in univariate analyses. Adjusting for microarray abnormalities, the odds for survival to discharge for RCDH compared with LCDH was 0.93 (0.38–2.30, p = 0.88). Conclusion Compared with LCDH, fetuses with RCDH had higher rates of adverse ultrasound predictors, but equivalent survival.

Perinatal Outcomes in Fetuses Prenatally Diagnosed with Congenital Diaphragmatic Hernia and Concomitant Lung Lesions: A 10-Year Review

2020 ◽  
Vol 47 (8) ◽  
pp. 630-635
Author(s):  
Shelly Soni ◽  
Julie S. Moldenhauer ◽  
Natalie Rintoul ◽  
N. Scott Adzick ◽  
Holly L. Hedrick ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Perinatal Outcomes ◽  
Lung Lesions

124: Perinatal outcomes in fetuses prenatally diagnosed with congenital diaphragmatic hernia (CDH) and concomitant lung lesions

2014 ◽  
Vol 210 (1) ◽  
pp. S75-S76
Author(s):  
Shelly Soni ◽  
Nahla Khalek ◽  
Juan Martinez-Poyer ◽  
Julie Moldenhauer ◽  
Mark Johnson ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Perinatal Outcomes ◽  
Lung Lesions

212: Ultrasound estimates of fetal lung volume: what is the best predictor of perinatal outcomes in congenital diaphragmatic hernia?

2014 ◽  
Vol 210 (1) ◽  
pp. S114-S115
Author(s):  
Amanda Trudell ◽  
Tasnim Najaf ◽  
Geetika Khanna ◽  
Alison Cahill ◽  
Methodius Tuuli ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Lung Volume ◽  
Perinatal Outcomes ◽  
Fetal Lung

scholarly journals 217: Prenatal diagnosis of congenital diaphragmatic hernia: does laterality predict adverse perinatal outcomes?

2017 ◽  
Vol 216 (1) ◽  
pp. S138
Author(s):  
Jefrey D. Sperling ◽  
Teresa N. Sparks ◽  
Victoria K. Berger ◽  
Jody A. Farrell ◽  
Kristin Gosnell ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Perinatal Outcomes ◽  
Adverse Perinatal Outcomes

scholarly journals Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiyoon Jeong ◽  
Byong Sop Lee ◽  
Teahyen Cha ◽  
Euiseok Jung ◽  
Ellen Ai-Rhan Kim ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Medical Records ◽  
Neonatal Outcome ◽  
Newborn Infants ◽  
Perinatal Outcomes ◽  
Fetal Lung ◽  
Prognostic Indicator ◽  
Lung Area ◽  
Large Cohort Study

Abstract Background Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare compared with left-sided congenital diaphragmatic hernia (LCDH). Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. The aim of this study was to report the treatment outcomes of patients with antenatally diagnosed RCDH and to evaluate the predictability of observed-to-expected lung area-to-head circumference ratio (O/E LHR) for perinatal outcomes, focused on mortality or extracorporeal membrane oxygenation (ECMO) requirement. Methods We retrospectively reviewed the medical records of newborn infants with isolated RCDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the O/E LHR, between the survivors and the non-survivors. Results A total of 26 (66.7%) of 39 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (64.7 ± 21.2) than in non-survivors (40.5 ± 23.4) (P =.027). It was greater in survivors without ECMO requirement (68.3 ± 15.1) than non-survivors or those with ECMO requirement (46.3 ± 19.4; P = .010). The best O/E LHR cut-off value for predicting mortality in isolated RCDH was 50. Conclusions The findings in this study suggest that O/E LHR, a well-characterized prognostic indicator in LCDH, could be applied to a fetus with antenatally diagnosed RCDH. A large cohort study is required to verify the association between O/E LHR values and the graded severity of RCDH.

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